PHYSIOLOGY

The Urinary System

ADAL MEDICAL UNIVERSITY
Dr. Abdirahman muse Farah
Organs of the Urinary system

 Kidneys (2)
 Ureters (2)
 Urinary bladder (1)
 Urethra (1)
 Regions of the Kidney

 Three regions of kidneys

 Renal cortex – outer region,
forms an outer shell
 Renal columns –
extensions of cortex-
material inward
 Renal medulla – inside the
cortex, contains medullary
(renal) pyramids
 Medullary pyramids –
triangular regions of tissue
in the medulla, appear
 Renal pelvis – inner collecting tube, divides into
major and minor calyces
 Calyces – cup-shaped structures enclosing the
tips of the pyramids that collect and funnel
urine towards the renal pelvis
 kidney
• Blood supply of kidney
Functions of the Urinary System
 Elimination of waste products
 filtering gallons of fluid from the bloodstream
every day creating “filtrate”
 “filtrate” includes: metabolic wastes, ionic
salts, toxins, drugs
 Maintenance of blood
 Red blood cell production- by producing
hormone erythropoietin to stimulate RBC
production in bone marrow
 Blood pressure (vessel size)- by producing renin
which causes vasoconstriction
 Blood volume (water balance)- ADH released from
Anterior Pituitary targets the kidney to limit water
loss when blood pressure decreases or changes in
blood composition
 Blood composition (electrolyte balance)- water
follows salt; aldosterone reclaims sodium to the
blood
 Blood pH- regulates H+ ions and HCO3- ions
Blood Flow in the Kidneys
 Rich blood supply to filter blood and adjust blood
composition
 ~¼ of blood supply passes through the kidneys
each minute
 Blood enters the kidneys under extremely high
pressure
 Renal artery arises from abdominal aorta, divides
into Segmental artery at hilus
 Inside renal pelvis, Segmental artery divides into
Lobar artery, which branch into Interlobar artery
travelling thru the renal column to reach the renal
cortex
 At the medulla-cortex junction, the Interlobar artery
curves over the medullary pyramids as the Arcuate
artery.
 Small Interlobular arterioles branch off of the Arcuate
artery and move away from the renal cortex and into
the Nephron of the kidney
Blood Flow in the Kidneys
 The final branches of the interlobular arteries are
called afferent
 arterioles.
 Afferent arterioles lead to the glomerulus, a
network of capillaries that are involved in filtration.
 Leading away from the glomerulus, blood less
filtrate travels through the efferent arterioles
and into the peritubular capillaries.
 From there, blood moves through similar veins
that parallel the arteries at their respective
locations.
Nephrons
 The structural and functional units of the kidneys
 Over 1 million
 Responsible for forming urine
 Consist of renal corpuscle and renal tubule
 Renal corpuscle composed of a knot of capillaries called
the Glomerulus (a.k.a. Bowman’s Capsule)
 Renal tubule- enlarged, closed, cup-shaped end giving
rise to the PCT, dLOH, aLOH, DCT, and CD.
Glomerulus
 A specialized capillary bed fed
and drained by arterioles.
 Glomerular capillaries filter
fluid from the blood into the
renal tubule
 GC is attached to arterioles on
both sides in order to maintain
high pressure
 Large afferent arteriole-arises from
interlobular artery (feeder vessel); large in
diameter, high resistance vessels that force
fluid & solutes (filtrate) out of the blood into
the glomerular capsule.
 99% of the filtrate will be reclaimed by the
renal tubule cells and returned to the blood
in the peritubular capillary beds(blood
vessels surrounding renal tubule) .
 Narrow efferent arteriole-merges to become
the interlobular vein; draining vessel.
Glomerulus
 Glomerular capillaries are
covered with podocytes from
the inner (visceral) layer of
the glomerular capsule.
 Podocytes have long,
branching processes called
pedicels that intertwine with
one another and cling to the
glomerular capillaries.
 Filtration slits between the
pedicels form a porous
membrane around the
glomerular capillaries.
 The glomerular capillaries sit within a glomerular
capsule (Bowman’s capsule)
 Expansion of renal tubule
 Receives filtered fluid
 Renal tubule coils into the PCT{proximal
convoluted tubule}, then the dLOH,
aLOH{descending and ascending loop of Henley},
DCT{distal convoluted tubules} and finally, the
CD{collecting duct}.
 Along the PCT, much of the filtrate is reclaimed
Renal Tubule
 Glomerular (Bowman’s)
capsule enlarged
beginning of renal
tubule
 Proximal convoluted
tubule- lumen surface
(surface exposed to
filtrate) is covered with
dense microvilli to
increase surface area.
 The descending limb of
 The ascending limb of the nephron coils tightly
again into the distal convoluted tubule
 Many DCT’s merge in renal cortex to form a
collecting duct
 Collecting ducts not a part of nephron
 Collecting ducts receive urine from nephrons
and deliver it to the major calyx and renal
pelvis.
 CD run downward through the medullary
pyramids, giving them their striped appearance.
Blood Supply of a Nephron
 Peritubular capillary
Efferent arteriole braches into a second
capillary bed
Blood under low pressure
Capillaries adapted for reabsorption
instead of filtration.
Attached to a venule and eventually
lead to the interlobular veins to drain
blood from the glomerulus
  Cling close to the renal tubule where they receive solutes
and water from the renal tubule cells as these substances
from the filtrate are reabsorbed into the blood.
 Juxtaglomerular apparatus
 At origin of the DCT it contacts afferent and efferent
arterioles
 Epithelial cells of DCT narrow and densely packed, called
macula densa.
 Together with smooth muscle cells, comprise the
juxtaglomerular apparatus
 Control renin secretion & indirectly, aldosterone
secretion
Types of Nephrons
 Cortical nephrons
 Located entirely in the cortex
 Includes most nephrons
 Juxtamedullary nephrons
 Found at the boundary of the cortex and medulla
and their LOH dip deep into the medulla.
Urine Formation Processes
 Filtration- Water &
solutes smaller than
proteins are forced
through the capillary
walls and pores (of the
glomerulus) into the
renal tubule (Bowman’s
capsule).
 Reabsorption- Water,
glucose, amino acids &
needed ions are
transported out of the
filtrate into the
• Secretion- Hydrogen ions, Potassium
ions, creatinine & drugs are removed
from the peritubular capillaries
(blood) and secreted by the
peritubular capillary cells into the
filtrate.
Filtration
 Beginning step of urine formation
 Occurs at the glomerulus, nonselective passive
process
 Water and solutes smaller than proteins are
forced through capillary walls of the glomerulus,
which act as a filter.
 Fenestrations – (openings in glomerular walls)
make glomerulus more permeable than other
arterioles.
 Podocytes cover capillaries, make membrane
impermeable to plasma proteins.
 Blood cells cannot pass
out to the capillaries; filtrate
is essentially
blood plasma
with out blood proteins, blood cells.
 Filtrate is collected in the
glomerular (Bowman’s) capsule
and leaves via the renal tubule
Filtration pressure
 Hydrostatic pressure of blood forces substances
through capillary wall.
 Net filtration pressure normally always positive
 Hydrostatic pressure of blood is greater than the
hydrostatic pressure of the glomerulus capsule
and the osmotic pressure of glomerulus plasma
 If arterial blood pressure
falls dramatically,
the glomerular
hydrostatic pressure falls below
level needed for filtration.
The epithelial cells of renal
tubules lack nutrients
and
cells die. Can lead to renal failure.
Filtration rate
 Rate of filtration is directly
proportional to net filtration pressure.
 Regulation of filtration rate
Rate typically constant; may need
to increase or decrease to maintain
homeostasis
 1. Sympathetic nervous system reflexes
 Respond to drops in blood pressure and blood volume
 As pressure drops, sympathetic nerves cause
vasoconstriction of afferent arterioles.
 Decreases rate of filtration
 Less urine produced, water is conserved
 As pressure rises, sympathetic nerves cause
vasoconstriction of efferent arterioles.
 Increases rate of filtration
 More urine produced, water is removed
Filtration rate
 2. Renin production by JGA
Renin is an enzyme controlling
filtration rate
Juxtaglomerular cells secrete renin in
response to 3 stimuli
Sympathetic stimulation (fast
response)
Specialized pressure receptors in
afferent arterioles sense decrease in
blood pressure
 Released renin reacts with angiotensinogen in
bloodstream to form angiotensin I  which is
converted into angiotensin II by the angiotensin I
converting enzyme, ACE
 Angiotensin II acts to vasoconstrict efferent arteriole
 Blood backs up into glomerulus, increasing pressure
and maintains filtration rate
 Angiotension II also stimulates secretion of
aldosterone from adrenal glands
 Stimulates tubular reabsorption of sodium & H2O
follows
Reabsorption
 The composition of urine is different
than the composition of glomerular
filtrate.
Tubular reabsorption returns
substances to the internal environment
of the blood by moving substances
through the renal tubule walls into the
peritubular capillaries (99%)
Some water, ions, glucose, amino
acids
 Some reabsorption is passive = water  osmosis
= small ions diffusion
 Most is active using protein carriers  by active
transport
 Most reabsorption occurs in the proximal convoluted
tubule, where microvilli cells act as transporters,
taking up needed substances from the filtrate and
absorbing them into the peritubular capillary blood.
 Substances that remain in the renal tubule become
more concentrated as water is reabsorbed from the
filtrate.
Reabsorption – sodium and water
 The sodium potassium pump reabsorbs
70% of sodium ions in the PCT.
The positive sodium ions attract
negative ions across the membrane as
well
  Water reabsorption occurs passively across the
membrane to areas of high solute concentration

 Therefore, more sodium reabsorption = more

water reabsorption
 Active transport of sodium
ions occurs along remainder
of nephron and
collecting duct
 Almost all sodium ions
and water are reabsorbed.
Materials Not Reabsorbed
 Nitrogenous waste products
 Urea – formed by liver; end product of
protein breakdown when amino acids
are used to produce energy
Uric acid – released when nucleic acids
are metabolized
 Creatinine – associated with creatine
metabolism in muscle tissue
 Excess water
 Secretion – Reabsorption in Reverse
 Some materials move from the peritubular
capillaries into the renal tubules to be eliminated in
urine.
 Example:
 Hydrogen ions; potassium ions
 Creatinine
 Drugs; penicillin; histamine
 Process is important for getting rid of substances
not already in the filtrate or for controlling pH.
 Materials left in the renal tubule move toward the
ureter
 Formation of Urine
Summary:
• glomerular filtration of
materials from blood
plasma
•Reabsorption of
substances, including
glucose; water, sodium
•Secretion of
substances, including
penicillin, histamine,
hydrogen and
potassium ions
 Maintaining Water Balance
 Normal amount of water in the
human body
Young adult females – 50%
Young adult males – 60%
Babies – 75%
Old age – 45%
 Water is necessary for many body
functions and levels must be
Distribution of Body Fluid

 Intracellular
fluid (inside
cells)
 Extracellular
fluid (outside
cells)
Interstitial
fluid
The Link Between Water and Salt
 Changes in electrolyte balance causes
water to move from one
compartment to another
Alters blood volume and blood
pressure (think of aldosterone)
Can impair the activity of cells
(swelling/edema)
Water intake must equal water
output
 Sources for water intake/output:
Intake: Ingested foods and fluids,
Water produced from metabolic
processes (glycolysis)
Output: Vaporization out of the
lungs, Lost in perspiration, Leaves the
body in the feces, Urine production
 Dilute vs. Concentrated Urine
 Dilute urine is produced if water intake
is excessive
 Less urine (concentrated) is produced
if large amounts of water are lost
 Proper concentrations of various
electrolytes must be present
Regulation of Water and Electrolyte Reabsorption
Regulation is primarily by
hormones
Antidiuretic hormone (ADH)
prevents excessive water loss in
urine
Neurons in the hypothalamus
produce ADH, which are
released by the anterior
pituitary gland in response to a
decrease in blood volume or
ADH increases the water
permeability of the distal
convoluted tubule epithelium to
the peritubular capillaries
Decreases volume of urine,
increasing concentration of
solutes
Negative feedback control
  Aldosterone regulates sodium ion
content of extracellular fluid
Triggered by the renin-
angiotensin mechanism
Stimulates the DCT to reabsorb
sodium and excrete potassium
 Cells in the kidneys and
hypothalamus are active monitors
Maintaining Water and Electrolyte Balance
 Maintaining Acid-Base Balance in
Blood
 Blood pH must remain between 7.35 and 7.45 to maintain
homeostasis
 Alkalosis – pH above 7.45
 Acidosis – pH below 7.35
 Most acid-base balance is maintained by the kidneys
 Excrete bicarbonate ions if needed
 Conserve / generate new bicarbonate ions if needed
 Excrete hydrogen ions if needed
 Conserve / generate new hydrogen ions if needed
 Regulation of these ions results in a
urine pH range of 4.5 to 8.0
 Acidic urine: protein-rich diet,
starvation, diabetes
 Basic urine: bacterial infections,
vegetarian diet
Urine composition
 Composition differs considerably
based upon diet, metabolic
activity, urine output.
 ~95% water, contains urea and
uric acid, electrolytes and amino
acids (trace amount)
 Volume produced ranges from
0.6-2.5 liters per day (1.8L
 Depends on fluid intake, body
and ambient air temperature,
humidity, respiratory rate,
emotional state
 Output of 50-60ml per hour
normal, less than 30ml per hour
may indicate kidney failure
Ureters
 Slender tubes attaching the kidney to the
bladder 10-12” long & ¼” diameter
 Superior end is continuous with the renal
pelvis of the kidney
 Mucosal lining is continuous with that lining
the renal pelvis and the bladder below.
 Enter the posterior aspect of the bladder at a
slight angle
 Runs behind the peritoneum
 Peristalsis aids gravity in urine transport from
 Smooth muscle layers in the ureter walls contract
to propel urine.
 There is a valve-like fold of bladder mucosa that
flap over the ureter openings to prevent backflow.
 Renal calculi= calculus means little stone; result
of precipitated uric acid salts created by bacterial
infections, urinary retention, and alkaline urine.
Lithotripsy or surgery are common treatments
 Urinary Bladder
 Smooth, collapsible, muscular sac
 Temporarily stores urine
 Located retroperitoneally in the pelvis
posterior to the pubic symphysis.
Urinary Bladder
 Trigone – three openings
 Two from the ureters (ureteral orifices)
 One to the urethra (internal urethral orifice)
which drains the bladder.
Common site for bacterial
infections
In males, prostate gland
surrounds the neck of the
bladder where it empties into
the urethra
Urinary Bladder Wall
 Three layers of smooth muscle
(detrusor muscle)
 Mucosa made of transitional
epithelium
 Walls are thick and folded in an
empty bladder 2-3” long
 Bladder can expand significantly
 As it fills, the bladder rises superiorly
in the abdominal cavity becoming
firm and pear shaped.
 A moderately full bladder can hold
~500mL (1 pint) of urine.
 A full bladder can stretch to hold
more than twice that amount.
Urethra

 Thin-walled tube that carries

urine from the bladder to the
outside of the body by
peristalsis
 Release of urine is controlled
by two sphincters
 Internal urethral sphincter (involuntary)
– a thickening of smooth muscle at the
bladder-urethra jxn. keeps urethra
closed when urine is not being passed.
 External urethral sphincter (voluntary)
-- skeletal muscle that controls urine as
the urethra passes through the pelvic
floor.
Urethra Gender Differences
 Length
 Females – 3–4 cm (1-1.5 inches)
 Males – 20 cm (7-8 inches)
 Location
 Females – along wall of the vagina
 Males – through the prostate and penis
 Function
 Females – only carries urine
 Males – carries urine and is a passageway for
sperm cells
Urethra Gender Differences
Females:
•Feces can enter urethral opening causing
•Uretritis-inflammation of the urethra
•Pyelitis or pyelonephritis-inflammation of the
kidneys
•Urinary tract infections-bacterial infection
•Dysuria
•Urgency
•Frequency
•Fever
•Cloudy urine
•Bloody urine
Males:
• Prostatic, membranous and
spongy (penile) urethrae
• Enlargement of the prostate gland
causes urinary retention
• can be corrected with a catheter
Micturition (Voiding)
 Both sphincter muscles must open to allow
voiding
 The internal urethral sphincter is relaxed
after stretching of the bladder ~200mL
 Activation is from an impulse sent to the
spinal cord and then back via the pelvic
nerves
 The external urethral sphincter must be
voluntarily relaxed
 Incontinence-inability to control micturition
The end